There is a group of diseases associated with increased metabolic rate we can describe these diseases by hypermetabolic disorders. Understanding the physiology of metabolism and factors that increase the basal metabolic rate open the way to discuss the hypermetabolism especially energy input, energy output, energy balance and effects of thyroid and adrenal hormones on basal metabolic rate. Also, declaring the importance of metabolic response in injury, nitrogen loss and energy expenditure in various injury states and the effects of injury on the metabolism of proteins, carbohydrates and lipids. Stress metabolism is a common feature in ICU patients especially acute stress metabolism which involves extensive neurohumoral modulation related to monokines, lymphokines, prostanoids, hormones, neural pathways, complement, and other endogenous mediators, which in turn drive metabolism and increase energy expenditure. We can conclude that there are common causes of hypermetabolism regarding the pathophysiology i.e., the febrile response, the inflammatory response, thyrotoxicosis, pheochromocytoma and burns. Monitoring of hypermetabolism will be through monitoring blood lactate, oxygen transport and oxygen in gastrointestinal tract i.e., gastric tonometry. Corner stones in management of hypermetabolic disorders are depending on prevention of hypermetabolism, supportive measures, therapeutic approaches of the associated diseases, drugs used for rescucitation of patients with hypermetabolism and a special concern was given to future therapy possible for hypermetabolism.